1. Part III Amy L. McIntosh, MD Pediatric Orthopedic Surgeon Mayo Clinic Rochester, Minnesota

2. Medical Therapy Supplements Over-the-counter medicines Prescription medicines Injection therapy

3. Supplements Little scientific evidence for/against products –Not subject to FDA regulations –Reasonable evidence for glucosamine / chondroitin helping with arthritic symptoms –No evidence for other compounds

4. OTC Medicines Tylenol NSAIDs – Ibuprofen (Advil) and Naprosyn (Aleve) –Equally effective in all major studies –Quite safe when taken with supervision Stomach ulcers Kidney trouble

5. Prescription Medicines Prescription NSAIDs –Celebrex, Mobic, etc –No better than ibuprofen or naprosyn in comparable doses Benefits for select patients Primary benefit is convenience –Cardiovascular risks unknown

6. Prescription Medicines - Opiates Synthetic derivatives of morphine –Effective –But… tolerance building and habit forming –Frequent depression and side effects –Used very selectively and carefully under specialty supervision

7. Physical Therapy Important aspect of joint care in SS Particularly important before and after any surgery

8. Injection Therapy Injection of cortisone or hyaluronic acid derivatives Effective in ~2/3rds patients Effect often fades Safe for up to 3-4 times/year

9. Surgical Treatment Fusion Arthroscopy Realignment / reshaping Joint replacement

10. Fusion Traditional treatment for arthritis in the young –“No motion, no pain” Not for patients with multiple joint involvement –Spine, ankle, wrist possible exceptions

11. Arthroscopy

12. Low morbidity outpatient procedure Doesn’t “burn” bridges –Effective against well defined targets Focally torn cartilage –Not effective for generalized joint pain or arthritis

13. Realignment Procedures - Knee Surgically change alignment to “offload” worn area Delay need for joint replacement

15. Realignment Procedures - Hip Impinging bump on the edge of a malformed femoral head (ball)